Paintsville pain clinic under fire

One doctor pleads guilty in drug case; second faces Ky. restrictions

Jan. 25, 2012

Tammy Cantrell is the owner of CareMore Medical Management. Her facility was raided by authorities earlier this year and 17 individuals were arrested along with the seizure of office files and computers. Also in the picture is her husband Aaron. Oct. 26, 2011 / Scott Utterback/The Courier-Journal

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R.G. Dunlop | The Courier-Journal

Aaron Cantrell, one of the owners of the Care More Medical Clinic tries to stop his picture from being taken. He and his wife, Tammy Cantrell are co-owers with Shelby Lackey and her husband. Care More now employs a physician who is a prolific prescriber of controlled substances. / Scott Utterback/The Courier-Journal

Dr. Rano Bofill operates out of the Care More Medical Management clinic in Paintsville. He refused to be interviewed for this story. / Scott Utterback/The Courier-Journal

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For more than two years, until his Feb. 16 arrest, Dr. Richard Albert doled out prescriptions for narcotics like candy on Halloween night.

He wrote them in the office for people who received only a cursory physical examination, or none at all. He wrote them on Easter Sunday in the living room of his home. He wrote them in a fast-food restaurant parking lot.

And sometimes he merely signed them, with clinic employees later filling in the blanks, including the patient's name and the narcotic drug being prescribed.

Visitors to the Care More Pain Management clinic, where Albert worked for at least nine months in 2009, paid in cash — $185 for a returning patient, $200 for a new one. Some spent no more than five minutes with Albert, court records show. Others didn't see him at all, and Albert would back-date information in their files when he returned to the office.

When law-enforcement personnel moved in after months of surveillance, recorded conversations and visits to Albert by confidential informants and officers working undercover, they raided Albert's home and two clinics, including Care More.

Since his arrest, Albert has been barred by a federal court order from practicing medicine. And on Dec. 12, he pleaded guilty to a federal charge of conspiring to illegally prescribe approximately 50,000 tablets of Percocet, a highly addictive narcotic pain-reliever.

He also agreed to forfeit assets of more than $500,000, which he kept in more than a dozen bank and investment accounts, and was taken into custody. He could be sent to prison for as long as 20 years when he is sentenced April 18.

But Care More, which paid Albert $8,500 per week for his services and which has changed its name to "Care More Medical Management," is still in business.

Before Albert's plea, Tammy Cantrell, one of the clinic's owners, denied that Cantrell violated the law while working there or that she knew what he was doing.

"He done his meanness after hours," Cantrell said in an interview. "What he was doing illegal was after hours, not on our time."

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However, court documents including the plea agreement Albert accepted last week show that Cantrell — who has no formal medical training — sometimes filled out the blank prescriptions that Albert had pre-signed. And the documents refer to a conspiracy to distribute drugs involving unnamed "others."

The plea agreement, for example, states that Albert "agreed with others to engage in a conspiracy to unlawfully distribute and dispense Percocet." The 64-year-old Albert was the only defendant in the case, and no one else has been charged. But the U.S. attorney's office in Lexington, which prosecuted Albert, said the investigation remains active.

Moreover, Care More now employs a physician, Rano Bofill, who has been disciplined in West Virginia for a drug-prescribing-related violation, who is practicing under sanctions imposed by the Kentucky Board of Medical Licensure and who himself is a prolific prescriber of controlled substances.

A 'PILL MILL'?

Records describe illegal activity at clinic

Local law-enforcement officials began receiving complaints from nearby businesses about unusual traffic around Care More in January 2008, according to the plea agreement, a 21-page affidavit prepared by U.S. Drug Enforcement Administration agent Lynne Thompson and other documents in Albert's case.

Large numbers of people were congregating in the parking lot, some apparently under the influence.

Thompson and other investigators confirmed the complaints, concluding that "criminal activity was afoot" and that Albert and Care More appeared to be running a "pill mill" that was "engaged in the wholesale distribution of controlled substances," according to the records.

Throughout the day, according to Thompson's affidavit, clinic staff would appear in the parking lot and yell for patients to come inside. Albert himself periodically went out to talk with some of them. Investigators noted people limping or staggering into the clinic, "only to emerge later with identifiable green prescriptions and not limping or staggering."

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In April 2009, a confidential informant visited the clinic and, after being told that Albert wasn't in, saw an "unknown female" writing prescriptions and was handed one for Percocet, a drug containing Oxycodone, as well as two other medications, according to the affidavit.

The informant also told investigators that Shelby Lackey, a co-owner of the clinic, "had provided him" with the three prescriptions and that Cantrell "may have been writing some of the prescriptions," the affidavit states.

When informants and undercover officers did not see Albert on other visits to the clinic, they nevertheless were given prescriptions that had been filled out "either by (Albert) or office personnel," according to the plea agreement.

Five months later, in September 2009, according to the plea agreement and the affidavit, DEA agent Thompson arranged an interview with Cantrell, who acknowledged that she, Lackey and their husbands owned the clinic — which had moved twice during the year and was now located up a hollow on Teays Branch Road, primarily an industrial area.

Cantrell confirmed Albert's salary, said he saw patients at the office after hours and on weekends, and that he had a side practice called Appalachian Pain, according to the affidavit.

According to Thompson's affidavit and the plea agreement, Albert was not in the office on Sept. 28, 2009, but "had pre-signed prescription blanks and she (Cantrell) had filled in the name, medication, etc."

"This practice had been in place for some period of time with the knowledge, participation and consent of the defendant, employees and owners of Care More and Care More itself," the plea agreement states. When Albert returned to the office, he "would document or back-enter the prescriptions in the patient files."

Cantrell also told Thompson, according to the documents, that Albert "falsified patient records by placing notations in the file that he had already seen the patients, when he had not."

'A CON ARTIST'

Co-owner of clinic lays blame at doctor's feet

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Following the release of new details in the plea agreement last week, Cantrell did not respond to messages left by the newspaper at Care More or with her husband at their home. But she acknowledged in the interview before Albert pleaded guilty that she has no training in health care and no college degree.

Asked how much money the clinic took in, Cantrell said, "That's none of your business," before hanging up the phone. In a later conversation, she contended that Care More did not make "much" of a profit.

"We was paying a man a lot of money and got screwed," Cantrell said. "He was a crook. We thought we had a good physician. Come to find out we had, I guess you would call, a con artist."

Asked about the assertion in court records that she filled out prescriptions that Albert pre-signed, Cantrell said, "I don't remember that. If we wrote any prescriptions, they were signed by him. It is not illegal to write a prescription for a doctor if they review and sign it."

But there is no indication in the records that before the prescriptions were given to patients, Albert "reviewed" the otherwise blank documents he had signed and that Care More personnel filled out.

And Mike Burleson, executive director of the Kentucky Board of Pharmacy, said the conduct described in the court documents is clearly wrong.

"No sir, that is not legal," he said after being read those portions of the documents outlining what Cantrell and Albert did. The doctor "shouldn't be signing blank prescriptions, and she shouldn't be filling them in. If I knew, as a pharmacist, that a (doctor's) office was doing that, I would not fill those prescriptions, because it's against the law to do that."

Although the federal government's investigation is ongoing, Cantrell said she is not concerned.

"We did everything by the book, as legally as possible," she said. "We've cooperated fully with their investigation. The local papers have made it look like we were in on all this with him, and we were not. But in a small town, truth don't sell."

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CARE QUESTIONED

Clinic's two doctors have faced sanctions

Albert had trouble with medical licensure authorities beginning more than two decades before his indictment.

In 1986, he surrendered his license in Virginia after a hospital in Chesapeake revoked his privileges for allegedly providing substandard patient care. The following year, the Kentucky Board of Medical Licensure placed Albert on probation for five years after he stated falsely on his Kentucky license application that he had not been disciplined anywhere during the previous year.

And while Albert was still working at Care More, investigators learned that he had been fired from a weight-loss clinic in Clark County, Ky., but continued to use its prescription pads and to see its patients outside a motel in Winchester or in a Dairy Queen parking lot in Paintsville, court records show.

Bofill, the doctor now working at Care More, has had his own share of disciplinary problems.

In 1988, after Bofill allegedly wrote prescriptions to a drug addict for nonmedical reasons, the West Virginia Board of Medicine restricted his practice to radiology for six months, limited his ability to prescribe controlled substances during that period and fined him $1,000.

The following year, for reasons that are not addressed in its order, the Kentucky licensure board placed Bofill on probation for three years, barred him from prescribing certain narcotics and restricted him to practicing radiology.

Then in 2005, Bofill was suspended by, and later resigned from, the Veterans Administration Medical Center in Lexington after a review disclosed that he had misread 14 of 29 scans.

Since then, additional restrictions on his Kentucky medical license have been imposed, loosened and imposed again, all in connection with concerns about his competence to properly interpret test results. Although the 69-year-old Bofill is a diagnostic radiologist by training, he currently is barred by the licensure board from interpreting several types of scans, including MRIs and CTs, as well as those used to detect cancer and other diseases.

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Although he completed remedial education in radiology in 2006, the board found that his diagnostic skills remained "clearly below minimum standards."

And in 2008, Dr. Steven Goldstein, a professor of radiology at the University of Kentucky's College of Medicine, and who has been retained by licensure board as a consultant, concluded after reviewing some of Bofill's cases that he "is woefully less qualified than any of our residents, none of whom have any experience in private practice or academics at this point."

The following year, records show, Bofill permanently surrendered his medical license in Florida, due to disciplinary actions in other states and his failure to report them in a timely manner. He also gave up his license in West Virginia, in part because Bofill made a false statement on a license application. And his Pennsylvania medical license is listed as suspended.

Despite the restrictions on his Kentucky medical license, Bofill is permitted to prescribe controlled substances. And state records show that he has become one of the state's most frequent dispensers of prescriptions for narcotics written to recipients of Medicaid, the federal health-insurance program for low-income people.

Last year and for the first half of 2011, Bofill ranked 20th statewide among dispensers of prescriptions for Oxycodone, and 47th for Hydrocodone prescriptions written, out of the thousands of doctors in the state who prescribed them to Medicaid recipients. Both controlled substances are widely abused by drug-seekers and others.

Overall during the same period, for seven commonly abused drugs, including Oxycodone, Hydrocodone and Xanax, Bofill ranked 38th in prescriptions in Kentucky.

Bofill, a 1966 graduate of the University of Santo Tomas medical school in the Philippines, has listed telephone numbers at addresses in Lexington and in Man, W. Va., but he did not respond to several telephone messages left at both locations. He also refused to be interviewed when stopped by a reporter at Care More early one morning when he arrived in an orange SUV with a West Virginia license plate bearing the letters "RAN."

As he stepped out of the vehicle, Bofill said only that he would let his lawyer speak for him. But the attorney, Stephen S. Burchett of Huntington, W. Va., also declined to answer questions.